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Gastroesophageal Motility Disorders Laboratory

Diagnosing Gastroesophageal Motility Disorders

For appointments and information, please call (212) 746-5130

The esophageal motility unit at NewYork-Presbyterian Hospital/Weill Cornell Medical Center focuses on the diagnosis and management of esophageal motility disorders. The unit provides diagnostic tests including esophageal manometry and pH studies. These tests are typically required to diagnose:

  • GERD
  • Achalasia
  • Diffuse Esophageal Spasm
  • Sphincter disorders

Nearly all patients referred to our institution will require an esophageal manomtery and sometimes a pH probe to determine the cause of their symptoms. Most studies have shown that reliance on symptoms alone has a high failure rate of surgical management in esophageal disorders.

Esophageal Manometry

The esophagus is a tube-like muscle connecting the back of the mouth to the stomach. During swallowing it contracts and pushes food from the mouth to the stomach. Esophageal manometry is a way to test whether the muscles in the esophagus are functioning properly. Esophageal manometry involves passing a small-diameter tube through the nose into the esophagus. Once the tube is in position, the patient is asked to swallow. Tiny holes in the sides of the tube allow for the measurement of pressures within the esophagus and stomach. The pressure readings indicate whether or not the esophageal musculature is contracting normally. Problems such as difficulty swallowing, pain with swallowing, heartburn, chest pain, regurgitating and vomiting can be associated with abnormal esophageal muscle function. This test helps physicians interpret whether there is a problem with motility of the esophagus or the function of the lower esophageal sphincter (LES).

Patients should not eat or drink for six (6) hours before the test. If you have diabetes, we will need to give you specific instructions. Please inform us if you are allergic to any drugs, such as lidocaine (similar to the anesthetic used by dentists when filling cavities). Patients with diabetes should ask about specific instructions.

Before the procedure, the nasal passage will be numbed with lidocaine jelly. This anesthetic is applied with a cotton swab. No other sedative or anesthetic is used. The tube will then be passed through the nose. The tube will not interfere with breathing. After the tube is passed, patients will lie down for the remainder of the test. Small amounts of water will be placed in the mouth and swallowed. The entire test takes between 30 mintues and one hour to complete. Following the test, patients can drive home and resume their usual diet and activities. A report will be sent to the physician who requested the test.

Esophageal manometry is an extremely safe test. Patients may have a sore throat for a few hours afterward, and the nose may be slightly irritated form the passage of the tube. Rarely patients have nosebleeds. Patients should let the technician know if they have a tendency for nosebleeds or have suffered a broken nose or are on blood thinners.

Ambulatory 24-Hour pH Probe

As a standard we use an ambulatory 24-hour pH probe that consists of a small tube passed through the nose into the esophagus at the level above the LES. A pH sensor at the tip of the tube allows measurements of acid exposure in the esophagus to be collected on a portable computer. You go home with the probe and eat 3 regular meals and tell the machine when you have symptoms, when you are eating, and when you are lying down. The pH probe is worn for 24 continuous hours. The tube is then removed and the results from the computer are interpreted. These results are compared to what we know is the normal acid exposure in the esophagus. This is considered the "gold standard" for determining if the patient has definitive evidence of reflux disease, or GERD. This test is required for most patients prior to surgery if they are planning to have reflux surgery.

Occasionally we use a recently-developed, special pH-measuring device that is clipped to the lining of the esophagus, so no tube through the nose into the esophagus is necessary. The pH sensor sends a message to a portable computer that collects data about esophageal acid exposure over 24 hours. The clipped probe in the esophagus slowly detaches itself from the esophagus and is ultimately passed in the stool and discarded.

Impedance

Impedance is occasionally offered when a patient's pH studies do not clearly show evidence of reflux. It involves the same type of procedure as a 24-hour pH test (a tube is passed through the nose into the esophagus at the level of the LES). It measures liquid movement from the stomach into the esophagus. This test may be important for people with reflux symptoms who are having bile reflux, not acid reflux, and therefore have normal results from a 24-hour pH probe. Unfortunately, impedance testing cannot be done with the current 24-hour pH-measuring device that is clipped to the lining of the esophagus.

Contact

Gastroesophageal Motility Disorders Facility
Directions
(212) 746-5130
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        Address: 525 E. 68th Street
        Starr 8
        New York, NY 10065
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